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Biomedical subjects

M Günter

Publications and source records attributed to M Günter.

18 recordsLinked to original sources
PubMed2001

Psychosocial care in children with stem cell transplantation.

The paper describes adaptation processes of children undergoing stem cell transplantation. Results from a prospective longitudinal study indicate two different levels of emotional adaptation. The children's good adaptation to the facts of treatment are a result of heavy inner work. The child's neuroticism and anxiety scores and the parents' coping style and experienced social support seem to have an influence on the occurrence of severe adjustment disorders during SCT. It is important to recognise the child's inner processes and the family's influences before and during SCT.

Adolescent↗
PubMed2000

Allegations of sexual abuse in child custody disputes.

OBJECTIVE: Allegations of sexual abuse are increasingly made in the context of divorce proceedings. The aim of the study was to describe ideal typical patterns of family dynamics when sexual abuse is alleged in divorce proceedings. METHOD: Development of an assessment plan according to the methods of the qualitative descriptive social sciences and retrospective assessment of 24 legal cases of custody and visitation right proceedings in which allegations of sexual abuse (N = 30 children) were made. RESULTS: In our sample, we found a significant incidence of sexual deviations of a parent. With respect to the allegations of sexual abuse in divorce cases, we were able to identify four types of family dynamics. Our qualitative assessment of the data showed that distinguishing between actual abuse and false allegations cannot adequately help to clarify the family dynamics. Rather, it tends to conceal the fact that even a false allegation usually originates from a sexualized atmosphere in the family. The main family structures which were observed without exception in our sample generally already existed before the separation phase and had corresponding effects on the child which must be considered in the evaluation.

Adolescent↗
PubMed1999

Psychiatric-psychotherapeutic crisis intervention for inpatient adolescents.

We assessed retrospectively in two periods of evaluation all inpatient crisis interventions (n1 = 75, n2 = 65) conducted in a psychiatric hospital for children and adolescents aged 13 to 19 years. In a first preliminary study we described patterns of family dynamics and developed an evaluation plan, which was used in the second study reported here. Familial conflict situations proved to be the essential factors. The adolescents' psychiatric diagnoses differed considerably from those of adult patients. Therapeutic management using a psychoanalytically oriented focal therapy and a more social-psychiatrically oriented crisis management is discussed. Data on adolescents' and families' collaboration as well as on the success of therapy are reported. It was possible to offer developmental prospects if the adolescents were able to consider their inner conflicts and if concurrently an agreement could be reached with the family. Collaboration with community health-care professionals, in particular with the appropriate social workers, was an important step in the majority of cases. Usually discharge to the home followed within a few days, in some cases to a supervised residence group. Twenty-three percent of patients required longer inpatient therapy.

Adolescent↗
PubMed1999

Emotional adaptation of children undergoing bone marrow transplantation.

OBJECTIVE: To examine stress reactions and psychic adaptation of children aged 8-12 years in single-room treatment under isolation conditions after bone marrow transplantation (BMT). METHODS: The prospective longitudinal study included free diagnostic interviews and a large test battery. We used a mixture of projective tests questionnaires and an intelligence test (the German version of the revised Wechsler Intelligence Scale for Children) to evaluate different adaptation processes. RESULTS: The questionnaires clearly showed children's strong tendencies to adapt to the situation and to normalize their behaviour under isolation conditions. In contrast, the psychoanalytic interview and the projective tests demonstrated a very differentiated emotional adjustment: Before transplantation, coming to terms with the life-threatening situation was deferred. After transplantation, very intensive emotional examination of the situation and superficial adaptation (protective denial) were observed. CONCLUSIONS: It is very important to intensify the child's and the family's psychosocial support before admitting the child for hospital treatment. Family conflicts and neurotic developments should be regarded as risk factors for marked and potentially dangerous stress reactions.

Adaptation, Psychological↗
PubMed1998

[Comparison of the body image of healthy and psychiatrically and chronically ill children using the KBMT-K].

UNLABELLED: Initially some results from empirical studies regarding body satisfaction and differentiation of body experience of children are described. METHOD: In our study several groups of children showing different kinds of illness at the age of eight to twelve years were subjected to the "Körperbildmaltest für Kinder" (KBMT-K, Günter) (Colour-A-Person-Dissatisfaction-Test for Children), a depression inventory and an anxiety test. Furthermore we examined the children's body knowledge. We assessed two samples of children in psychiatric and psychotherapeutic inpatient treatment. The diagnoses were disruptive behaviour (n = 32) or emotional disturbances (n = 36). Three other groups were formed of children with somatic chronic illnesses (asthmatics (n = 47), inpatient diabetics (n = 34) and outpatient diabetics (n = 30)). We compared the test scores with those of healthy children. RESULTS: Only the younger (eight to ten years old) children of both samples showed a significantly lower body satisfaction in comparison to healthy children, the young girls with a chronic somatic illness having the lowest scores. Older girls with a chronic somatic illness (aged 11 or 12 years) had a significantly poorer differentiation of their body experience than the healthy peers, a finding we had not expected in advance. Comparing the different clinical samples with the healthy sample, only the emotionally disturbed children were significantly more dissatisfied with their own body. Whereas we were able to demonstrate by statistical analyses that in addition to the illness, depression and anxiety had an impact on body image, the knowledge of the body did not influence the above-mentioned concepts. The results are discussed.

Affective Symptoms↗
PubMed1998

Induction, identification or folie à deux? Psychodynamics and genesis of Munchausen syndromes by proxy and false allegations of sexual abuse in adolescents.

When dealing with Munchausen syndrome by proxy as well as with false allegations of sexual abuse, we normally were confronted with complex family dynamics especially between mother and child. To date there are no scientific discussions on the importance of these dynamics for the development of manifest symptoms in the child and regarding the child's contribution. The descriptions of the Munchausen syndrome by proxy stressed the maternal pathology from which the child's symptoms seemed to be derivable by the concept of simple induction. Regarding false allegations of sexual abuse, especially in divorce proceedings, even publications on the motives of the inducing parents were rare. This paper presents considerations on the object relation dynamics as well as on the intrapsychic dynamics of the children and adolescents in question. Related forensic psychiatric problems are discussed.

Adolescent↗
PubMed1997

[Termination of inpatient treatment as a crisis and developmental tasks].

Especially in the inpatient treatment of adolescents the phase of termination is decisive, because important issues and developmental tasks are re-experienced by the young patient. Therefore a sufficient relief from symptoms cannot serve as the main criterium for termination. Instead the ego-development with all its aspects and the improvement of the capacity for emotional relationship is most important. The paper discusses some central dynamic factors of the termination phase. Most of these processes are also induced inside the therapeutic team thus leading also to a kind of separation crisis in the team.

Adolescent↗
PubMed1995

[Rehabilitation access for emotionally handicapped children and adolescents: qualification of standard institutions--construction of special institutions].

In order that pedagogic institutions in the system youth care can take care of children and youths who are mentally disabled due to a mental disturbance in the manner necessary certain institutional conditions must exist. For a small group of youths with especially severe mental disorders additional special ambulatory and in-patient assistance offers are necessary. This special need is explained with examples. General standards and special institutions are described in detail. A reliable cooperation between the system of youth care and the individual expert departments in the child and youth psychiatry is conditional for the effectiveness of the assistance offers.

Adolescent↗
PubMed1994

[Significance of "abnormal reaction susceptibility" of adolescents in Munchausen by proxy syndrome. Simulation, folie à deux, induced artefact disease or what else?].

There are very few publications about the induction of emotional disturbances in Munchausen by proxy syndrome, although we see these children in our clinical work. While the pathology of the inducing mothers has been described quite well, the equally important question of pathological reactions of the child, which is a major factor at least in adolescents, has not yet been discussed. We present an unusual case of induced borderline psychosis and discuss the above mentioned aspect in relation to several psychopathological concepts, particularly Erikson's identity diffusion and folie à deux. We conclude that the concept of a simple induction of the disturbance in adolescents, which has been used so far, is insufficient. According to the authors the importance of the reactions discussed in this paper reaches far beyond Munchausen by proxy syndrome. The same reactions can for example be seen also in cases of sexual abuse. A bigger sample of patients needs to be investigated to confirm our considerations.

Adolescent↗
PubMed1991

[Inpatient crisis intervention in psychiatric crises in adolescence].

The study reports on 76 cases of crisis intervention concerning 49 adolescent patients within a period of 3.5 years. The case files were evaluated retrospectively. The crises were closely associated with intrafamiliar conflicts. Three types of familiar problems were identified. 54% of all crisis interventions followed an attempted suicide or suicidal threats. In a group excluding the mentally ill patients the incidence of suicide was even higher. Only mentally ill crisis patients were admitted for crisis intervention more than once. These patients had usually been in previous outpatient or inpatient treatment at the same hospital. The duration of inpatient crisis intervention exceeded the limit of two weeks only in psychiatrically ill patients. All suicidal patients were discharged after only a few days. The average length of stay was 4 days. In contrast to other adolescent inpatient populations there was a notable higher proportion of girls not only among the suicidal patients.

Adolescent↗
PubMed1990

[Art therapy in the psychiatric clinic. A historical analysis of the development of art studios].

The present study examines the building up of art classes in psychiatric hospitals in the thirties and forties of this century. Until 1950 the worldwide total of 34 art classes had come into being. The growing psychiatric interest in drawings of patients in the 19th century is related to changes in psychiatric theory moving from "moral treatment" to descriptive psychiatry at the turn of the century. All in all the installation of 11 artistic workshops for patients can be traced before the 1st world war. They were part of work therapy in german private clinics as a means to put patients of a higher social standing to a regular activity instead of field and garden work, which was medically indicated but socially unacceptable. During the course of development of a diagnostic interest since 1870 the drawings were all along considered to be the immediate expression of the patients inner world. Such a view had become possible, after in modern art the conceptions about the meaning of art had changed. Paradigmatically this connection can be shown in the work of Prinzhorn. First therapeutic attempts were then started by different psychoanalysts especially in the treatment of children. These formed an important basis for the establishment of art classes in psychiatric hospitals later on. Painting was now considered as a means to approach the hidden unconscious. The study continues to explain in which way the therapeutic applications of art therapy depended on the convergence of view points in esthetic and therapeutic theory.(ABSTRACT TRUNCATED AT 250 WORDS)

Art Therapy↗
PubMed1989

[Rapidly changing ego states in inpatient long-term therapy of psychotic adolescents].

The paper reports about some aspects of a major retrospective case study of 43 psychotic adolescents in long term in-patient treatment. One of five items to classify these treatments were rapidly changing ego-states. In 17 patients this phenomenon was seen as having essential repercussions on the therapeutic course. The discussion is centered round the day by day interactions with these patients on the ward. The question is raised, how holding structures and continuity of personal relations can be reached and maintained in view of rapidly changing levels of ego functioning. Much emphasis is laid on the understanding of interpersonal dynamics between nursing staff and patients. Such understanding enables the team to adapt to the patients' needs without being overwhelmed by their impact. A thus reflected shaping of everyday interactions on the ward is highlighted as an essential factor in the treatment of psychotic adolescents. The term "rapidly changing ego-states" refers to the adolescent problem of maturation and separation and to the restating of this problem in a treatment setting. Mental illness evolves to be understood a developmental crisis.

Adolescent↗